Blog #42: The Coloring of the Hippocratic Oath
The Hippocratic Oath begins, “First, do no harm…”. However, in the “Tuskegee Study of Untreated Syphilis in the Negro Male,” racism led physicians to violate this sacred promise. From 1932-1972, the U. S. government consistently deceived and lied to 600 Black sharecroppers in Macon County, Alabama, resulting in suffering, death, and distrust.
As Prof. Allan Brandt explained, “the Tuskegee Study revealed more about the pathology of racism than it did about the pathology of syphilis.” Researchers assumed racist paradigms of Black Americans as naturally inferior and suffering “mental, moral, and physical deterioration.” Decades of lies deceived 399 subjects into thinking they were receiving treatment when they were intentionally denied it. The U. S. Public Health Service (USPHS) sent misleading letters titled "Last Chance for Special Free Treatment.” Such “treatments” included “spinal shots, ” painful spinal taps that offered no medicine, but only withdrew fluid for analysis.
Dr. O. C. Wegner, chief of a federally operated venereal disease clinic, praised researchers while admitting that the study mainly wanted to examine the cadavers of those ravaged by life-long syphilis. He wrote, “As I see it, we have no further interest in these patients until they die.” Authorities promised $50 to each subject for funeral expenses, if, and only if, they agreed to being autopsied after their deaths. After effective penicillin became available in the 1950’s, the USPHS made sure patients went untreated. It told the draft board to exempt 256 subjects from induction into the armed forces so that the military would not treat them. Mobile VD units were steered away from these men for the same reason.
The damage done is clear: prolonged suffering; at least 28 - but possibly 100 - deaths; the infection of 40 wives; 19 infants born with congenital syphilis. In addition, the Tuskegee University was harmed by cooperating with the U. S. government on what it thought was a prestigious program. Eunice Rivers, a Black nurse intentionally hired to engender trust in the subjects, was manipulated during her 40 years of dedication to the study. Modest financial settlements and President Clinton’s 1997 apology hardly seemed enough. Clinton admitted that “what the United States government did was shameful, and I am sorry…. To our African American citizens, I am sorry that your federal government orchestrated a study so clearly racist.” Unfortunately, this was just one example of a history of racism in medicine, as we will see in my next blog.
Lesson #213: Subjects were told that they were being treated for "bad blood," a colloquialism that usually referred to syphilis, but also other conditions. At the start of the program, small doses of treatment – such as ineffective mercurial ointment and inadequate doses of neoarsphenamine – were administered. This intervention actually invalidated the study from the start. After that, no real treatment was offered for the remaining decades.
Lesson #214: Due to such exploitation, distrust of public health efforts is high in the Black community. Many Black citizens believed that the government infected the subjects with syphilis. In the 1980’s one study indicated that 30% of Black citizens said they didn’t rule out that the AIDS epidemic was a government plot.
Lesson #215: When President Clinton apologized to surviving Tuskegee study subjects he said, “What was done cannot be undone. But we can end the silence. We can stop turning our heads away.” Unfortunately, there still is too much silence in the medical community about racial bias. See Baltimore Ethical Society member’s article, “White Privilege in a White Coat: How Racism Shaped my Medical Education” to learn more.
Lesson #216: It was not just the U. S. Public Health Service that betrayed trust in institutions purportedly seeking to protect the public from abuse. In the 1960’s the Centers for Disease Control (CDC), then in control of the study, pushed for it to be completed. The CDC was supported by both the American Medical Association (AMA), and, sadly, the National Medical Association (NMA) which represented African-American physicians.
Lesson #217: Despite many opportunities for people to point out the unethical nature of the study, it was not until 1972, when whistleblower William Buxton leaked the story to the press, that it was discontinued. This led to the institutionalization of informed consent and other safeguards.
Lesson #218: Unfortunately, unethical studies still occur. On January 3, 2019, a U.S. District Judge stated that Johns Hopkins University, Bristol-Myers Squibb and the Rockefeller Foundation must pay out a $1 billion lawsuit for their roles in a similar experiment affecting Guatemalans.